Contents 1 Pinyin 2 English reference 3 Overview 4 Disease name 5 English name 6 Alias ??of spinal arachnoiditis 7 Classification 8 ICD number 9 Epidemiology 10 Causes of spinal arachnoiditis 10.1 Infection 10.2 Trauma 10.3 Spine and lesions of the spinal cord itself 10.4 *** of chemical drugs 10.5 Unknown cause 11 Pathogenesis 12 Clinical manifestations of spinal arachnoiditis 12.1 Medical history and course of disease 12.2 Symptoms of nerve root irritation 12.3 Sensory impairment 12.4 Movement impairment 12.5 Sphincter disorder 13 Spinal arachnoiditis Complications 14 Laboratory tests 15 Auxiliary tests 15.1 Spinal lipiodol angiography 15.2 CT and MRI examination 16 Diagnosis of spinal arachnoiditis 17 Differential diagnosis 17.1 Spinal cord tumors 17.2 Subacute combined degeneration 17.3 Intraspinal tumors 17.4 Intervertebral disc herniation 17.5 Other diseases 18 Treatment of spinal arachnoiditis 18.1 Medical treatment 18.2 Surgical treatment 19 Prognosis 20 Prevention of spinal arachnoiditis 21 Related drugs 22 Related examinations attached: 1 Related drugs for spinal arachnoiditis 1 Pinyin
jǐ suǐ zhū wǎng mó yán 2 English reference
spinal arachnoiditis 3 Overview
Spinal arachnoiditis is a chronic inflammatory process of the arachnoid membrane. Under the influence of certain causes, the arachnoid membrane gradually thickens. , causing damage to the spinal cord and nerve roots, or forming cysts to block the medullary cavity, or affecting blood circulation in the spinal cord, and finally leading to dysfunction. Most of them are between 30 and 60 years old, with more men than women.
Spinal arachnoiditis usually has a subacute or chronic onset, and the course of the disease can range from months to years. The symptoms may be mild or severe, and there is often a remission period. There may be a history of cold, fever or trauma. Some symptoms of spinal cord inflammation or paralysis occur without obvious reasons. The symptoms often worsen after fever, injury, or exertion, and are relieved after rest, physical therapy, or anti-inflammatory treatment.
Spinal arachnoiditis may cause high intracranial pressure syndrome.
First of all, non-surgical treatment should be considered. For early mild cases of spinal arachnoiditis, the symptoms can disappear or be alleviated after treatment, and comprehensive treatment is generally used. The indications for surgical treatment are limited to cases of spinal arachnoiditis with localized adhesions and cyst formation. In cases of diffuse adhesions, the blood vessels supplying the spinal cord and nerve roots are entangled with the pia mater. Trying to separate these adhesions will cause Further damage to the spinal cord and blood vessels.
For those who have no obvious obstruction in the subarachnoid space and whose limbs are only paralyzed, the prognosis is generally good, and most of them can recover to varying degrees through drug and other treatments. It is necessary to promptly treat and prevent various primary diseases; prevent infection of adjacent tissues of the spinal cord from involving the arachnoid membrane of the spinal cord; strictly implement routine diagnosis and treatment operations to prevent iatrogenic infections caused by neurosurgery and diagnosis and treatment operations. 4 Disease name
Spinal arachnoiditis 5 English name
spinal arachnoiditis 6 Alias ??of spinal arachnoiditis
arachnoiditis of spinal cord 7 Classification
1. Neurology> Spinal cord diseases
2. Neurosurgery> Spine and spinal cord diseases> Spinal canal infections and parasitic diseases 8 ICD number
G05.8* 9 Epidemiology
Most cases are between 30 and 60 years old, with more men than women. According to general statistics, the thoracic segment is the most affected, and the cervical and lumbosacral segments are less frequently affected.
In the 10 years of Beijing Tiantan Hospital (1982-1992), 15 of the 842 cases of spinal canal lesions were found: 2 in the cervical segment, 9 in the thoracic segment, and 4 in the lumbar segment. 10 Causes of spinal arachnoiditis 10.1 Infection
Infection is the main cause of spinal arachnoiditis. Before the onset of illness, there is often a history of colds, fever, and systemic infections such as boils, tuberculosis, appendicitis, pelvic inflammatory disease, and meningitis. Some people believe that it is caused by viral infection. 10.2 Trauma
Trauma is also a common cause of spinal arachnoiditis, such as spinal fractures and dislocations and spinal cord surgery. It was reported that arachnoid adhesions were found in 23 cases of 54 cases of vertebral root resection with spinal war injuries. .
10.3 Lesions of the spine and spinal cord itself
Epidural abscess, subdural abscess, intraspinal abscess, intraspinal tumor, spinal vascular malformation rupture, subarachnoid hemorrhage, intervertebral disc herniation, spinal tuberculosis Spinal lesions such as osteomyelitis and osteomyelitis can be complicated by arachnoiditis or have arachnoiditis after treatment. 10.4 *** of chemical drugs
Such as intracanal antibiotics and various contrast agents, anesthetics and other chemical drugs. 10.5 Unknown cause
Although there are many causes, a considerable number of cases of spinal arachnoiditis still have no cause, and the proportion can be as high as 44% to 66%. 11 Pathogenesis
The arachnoid membrane itself has little blood supply and lacks the ability to respond to inflammation. Under pathogenic infection, the dura mater and pia mater, which are rich in blood vessels, can undergo active inflammatory reactions. The scope of the disease can often involve several spinal cord segments. In the chronic stage, the fibers of the arachnoid become thickened, gray in color, lose transparency and appear turbid, and sometimes white spots of varying sizes appear. These lesions are often associated with the dura mater, pia mater, and pia mater. Adhesions to the spinal cord or nerve roots. In the early stage, the blood vessels on the surface of the spinal cord are congested and expanded, and in the late stage, the blood vessel walls thicken, causing the vascular cavity to shrink. Secondary changes and softening of the spinal cord or the formation of a cavity. The edges of the cavity are connective tissue, surrounded by glial cell proliferation, arachnoid adhesion, and cyst formation, which can directly compress the spinal cord, causing local ischemia, atrophy, and degeneration of the spinal cord. In severe cases, myelomalacia can occur. Necrosis. Inflammatory adhesion can be divided into localized and diffuse. Due to arachnoid adhesion, one or multiple cysts are formed. The thickened arachnoid membrane forms a cyst, and the fluid in the cyst gradually increases, causing compression of the spinal cord. Therefore, spinal cord ischemia and compression caused by arachnoid adhesions and cyst formation are the pathological basis of spinal arachnoiditis. 12 Clinical manifestations of spinal arachnoiditis
Spinal arachnoiditis is more common in thoracic and cervical spinal cord lesions. In the early stage, it often presents with posterior root *** symptoms, resulting in radicular pain in the affected area of ??the nerve root. The severity varies, and can be relieved after rest. It often lasts for months and years before symptoms of spinal cord compression appear in varying degrees. There are also cases where transverse spinal cord damage occurs at the beginning, but this is rare.
Except for a few localized cases, the most characteristic symptoms are those caused by one main lesion, and they often present multiple symptoms, such as: on the limbs above or below the transverse level, There is localized atrophy of the trunk or extensive muscle fiber tremors, etc.
The onset is slow and there may be temporary relief as the disease progresses. There are also cases where symptoms worsen rapidly once symptoms of spinal cord transection appear. In the early stage, there is often root pain. Later, symptoms of spinal cord compression gradually appear, such as weakness in the lower limbs and unsteady walking. Damage to the upper limbs may include weakness in holding objects and muscle atrophy. Paraplegia or quadriplegia develops slowly and is spastic. Urinary and fecal sphincter disorders are generally mild, and may include sensory and autonomic nervous system dysfunction. When there is damage to the cauda equina area, one or both lower limbs will experience pain, lower limb muscle tone will decrease, knee tendon reflexes will disappear, and then obvious muscle atrophy will appear. Almost all patients will have difficulty in defecation and defecation, and there will be a loss of deep and shallow sensation below the level of damage. The cone is damaged, mostly around the vagina and symmetrical sensory disturbances may occur in the vagina. 12.1 Medical history and course of disease
Most symptoms are subacute or chronic in onset, and the course of disease can range from months to years. Symptoms may be mild or severe, and there is often a remission period. There may be a history of cold, fever or trauma. Some symptoms of spinal cord inflammation or paralysis occur without obvious reasons. The symptoms often worsen after fever, injury, or exertion, and are relieved after rest, physical therapy, or anti-inflammatory treatment. 12.2 Symptoms of nerve root irritation
Symptoms of nerve root irritation are the most common first symptom, which is because the lesion occurs on the dorsal side of the spinal cord. It manifests as spontaneous pain, often in a wide range but limited to 1 to 2 nerve roots. Some radiate along the nerve root distribution area or have a band-like sensation. Symptoms can be aggravated when coughing, sneezing or exercising. Lesions in the lumbosacral segment and cauda equina can cause low back pain and radiate to the lower limbs, manifesting as sciatica. Symptoms are aggravated at night and are often bilateral. 12.3 Sensory impairment
is the second most common symptom, but the symptoms of spinal cord conduction tract damage often appear months or years after the symptoms of posterior root irritation of the spinal cord. The level of sensory impairment is often not obvious and the distribution is uneven. Irregular and often inconsistent with movement disorders. Sometimes there may also be a phenomenon of sensory dissociation in which pain and temperature sensation disappear but touch is normal. 12.4 Movement disorders
Movement disorders manifest as progressive muscle weakness. Cervicothoracic lesions manifest as spastic paralysis of the lower limbs, hyperreflexia of tendons, clonus and pathological reflexes. Lumbosacral lesions often cause flaccid paralysis of both lower limbs and varying degrees of muscle atrophy. 12.5 Sphincter disorders
Sphincter disorders appear late or are not obvious, with intermittent urinary retention or urinary incontinence. 13 Complications of spinal arachnoiditis
High intracranial pressure syndrome may occur in spinal arachnoiditis. 14 Laboratory tests
During lumbar puncture, the cerebrospinal fluid pressure is often lower than normal or normal. Queckenstedt test shows partial obstruction in 1/2 and complete obstruction in 1/4. The color of cerebrospinal fluid is colorless, transparent or Yellow color and protein content are increased to varying degrees. In a few cases, the number of white blood cells is increased, mainly lymphocytes.
Sometimes the clinical symptoms are severe but the degree of obstruction is mild, which is different from tumors. In a few cases, symptoms may worsen after lumbar puncture. When the same patient undergoes repeated lumbar puncture, sometimes obstruction and sometimes patency are the characteristics of spinal arachnoiditis. 15 Auxiliary examination 15.1 Lipiodol myelography
Lipiodol is dispersed in spots or irregular strips, similar to "candle tears", and flows slowly in a long area in the spinal canal. The formation of the iodine column may be inconsistent when observations are repeated. Generally, there is a lack of clear boundaries, and the plane of lipiodol obstruction does not necessarily match the clinical symptoms. Local sudden obstruction or filling defect may occur, and the shape of the obstruction end is irregular or jagged. In some cases of spinal arachnoiditis, the obstruction appears as the so-called " Cup-like shape needs to be distinguished from intraspinal tumors, which are generally not accompanied by signs of spinal cord displacement. Lipiodol angiography of the spinal cord has a high diagnostic value, but this test is generally not performed because it can aggravate the condition. 15.2 CT and MRI examination
The diagnostic value of CT scan is limited. Post-myelography CT scan (CT myelography, CTM) can show changes in adhesions. In the early stage, at the end of the dural sac, it shows irregular narrowing of the subarachnoid space of the spinal cord, nerve roots adhesion to each other and losing their normal appearance, and adhesion to the surrounding dural sac showing the "empty dural sac" sign. The dural sac There are no nerve roots inside, only the contrast agent is filled, and the adhesions between the cyst wall and the nerve roots show thickening. If the adhesion is severe, the nerve roots that are adhered together will form a tubular block. Local adhesions to the dural sac may reveal irregularities in the nerve roots and dural sac. The cyst formed due to adhesion is connected to the subarachnoid space of the spinal cord, and delayed CTM shows that the contrast agent enters the cyst. MRI mainly shows that adhesion and hypertrophy of soft tissue shadows in the medullary cavity can be seen in the sagittal and axial views, showing long T1 and long T2 signals, irregular shape, and can be intermittent; local cystic type shows longer T1 and long T2 The signal has a mass effect and can compress the spinal cord and nerve roots. There is generally no enhancement after injection of GdDTPA. 16 Diagnosis of spinal arachnoiditis
After a cold or fever or systemic infectious disease, symptoms of spinal cord compression combined with multiple nerve root involvement appear, with a fluctuating course of exacerbation and remission, and multiple nodes. Segmental sensory impairment is characterized by irregular levels, bilateral symmetry, leukocytosis in the cerebrospinal fluid, and spotty distribution of oil columns or irregular narrowing of the spinal cord cavity on spinal cord lipiodol angiography. The diagnosis is generally not difficult. Typical manifestations of lipiodol angiography can often confirm the diagnosis. 17 Differential Diagnosis
If the iodine block is cup-shaped or has more regular obstruction, it is difficult to distinguish it from spinal cord tumors. MRI or surgical exploration should be combined to make it clear. Attention should be paid to the following during identification: 17.1 Spinal cord tumors
It is difficult to differentiate between tumors outside the spinal cord and this disease because both have radicular pain and spinal canal obstruction. However, the transverse damage of spinal cord tumors is particularly serious and there is no relief during the course of the disease. In some patients with complete obstruction, the distance between vertebral pedicles can be seen to be widened on spinal cord plain films. The T1-weighted image of spinal cord cysts on MRI shows uniform low signal, and the T2-weighted image shows high signal, with no enhancement. 17.2 Subacute combined degeneration
The injury sites are the posterior and lateral cords of the spinal cord, and it is most common in middle-aged and elderly people. In the early stages of the disease, there is numbness in both hands, and later spinal cord damage gradually occurs, including deep sensory impairment, urinary and fecal sphincter disorders, unsteady walking, and positive pyramidal tract signs. However, there is no obstruction in the spinal canal and normal cerebrospinal fluid examination. Most patients suffer from achlorhydria, and some patients have mild anemia or pernicious anemia. The main cause is vitamin B12 deficiency. 17.3 Intraspinal tumors
The onset is slow and there is no obvious cause. The symptoms gradually worsen. There is a clear level of spinal cord involvement. The number of cells in the cerebrospinal fluid does not increase, but the protein content increases. Plain X-ray films may show changes in the inner edge of the pedicle being absorbed and the intervertebral foramen being enlarged. Lipiodol myelography shows a well-defined level of obstruction. MRI shows localized entities or space-occupying lesions with cystic changes in the spinal canal. In intramedullary tumors, localized thickening of the spinal cord can be seen, with TlW1 being slightly hypointense and T2W1 being slightly hyperintense or obviously hyperintense. Signal strength is often uneven. Observed from all directions, the subarachnoid space around the lesion was narrowed or occluded. Secondary syringomyelia is common. Subdural tumors commonly cause spinal cord compression and deformation, with displacement to the opposite side. The subarachnoid space on the side of the tumor widens, while the subarachnoid space on the contralateral side of the tumor narrows. Linear low-signal dural shadows can be seen between the epidural tumor and the spinal cord, and the epidural fat disappears. The adjacent subarachnoid space narrows, and the spinal cord is compressed and displaced to the opposite side. 17.4 Intervertebral disc herniation
Most often have a history of trauma and develop suddenly. In the lumbosacral region, the nerve roots are often involved. In cases of central type in the cervical, thoracic or lumbar segments, the spinal cord or cauda equina may be affected. Myelography contrast agent has a filling defect or obstruction at the intervertebral space level. CT examination showed localized herniation of the posterior edge of the intervertebral disc. On the sagittal MRI, it can be seen that the intervertebral disc becomes flattened and then the dural sac is compressed. 17.5 Other diseases
Spinal vascular malformations, combined degeneration of the posterior and lateral cords, and occipitocervical region malformations also need to be considered and ruled out. It is not difficult to rule out the above diseases using CT and MRI. 18 Treatment of spinal arachnoiditis 18.1 Medical treatment
First of all, non-surgical treatment should be considered. For early mild cases of spinal arachnoiditis, the symptoms can disappear or be alleviated after treatment, and comprehensive treatment is generally used.
When symptoms of acute infection such as fever worsen, penicillin, streptomycin or other antibiotics can be used. Although it is believed that corticosteroids can be injected into the spinal canal to treat arachnoiditis, they themselves can also cause arachnoiditis. Therefore, intravenous infusion is often used clinically. Hydrocortisone 100 to 200 mg or dexamethasone 10 to 20 mg daily. Gradually reduce the dosage after 2 to 4 weeks and repeat if necessary. 40% methenamine 5 mg plus 5% glucose 20 mg intravenously, 2 times/d, 10 to 20 days as a course of treatment. Vitamins: such as oral potassium iodide, and the use of vitamin B1, vitamin B12, niacin, etc.
Subarachnoid gas injection: It has a certain effect in separating adhesions in early cases or preventing postoperative adhesions. Each gas injection is 10 to 20 ml, 1 to 2 times a week, and 4 to 6 times is a course of treatment. . Acupuncture, massage, and functional strengthening exercises. For patients with difficulty walking, a wheelbarrow or brace should be designed.
If you are not satisfied with drug treatment, you can use hormone treatment. Prednisone (prednisone) 10 to 15 mg orally, 3 times/d or dexamethasone 2 to 5 mg intrathecally, 1 to 2 times a week. It has been reported that intraspinal injection of hyaluronidase is effective, 500U each time, 1 to 2 times a week. Surgical laminectomy to decompress or peel off adhesions is not very effective and is only effective for cystic patients. Individual patients experienced slight improvement after receiving a small amount of radiation therapy.
In cases where infection is suspected or confirmed, antibiotics or antiviral preparations may be given. In some cases, even if there is not much evidence of tuberculosis, anti-tuberculosis treatment can be given first. If there is an effect in about two weeks, tuberculosis treatment can be continued.
To dilate blood vessels and improve blood circulation, you can use niacin, dibazole, scopolamine (6542), scopolamine injection, etc.
Agents that promote neuronal cell metabolism and vitamin B1, vitamin B12, etc. only have a general protective effect on nerve tissue and are difficult to restore spinal cord function. Traditional Chinese medicine treatment can be tried.
In addition, intraspinal air injection therapy can also be used, injecting 10 to 15ml at a time as appropriate. Starting from a small amount, every 5ml of gas injected will release the same amount of cerebrospinal fluid, once every 5 to 7 days, which may be helpful in loosening adhesions and improving cerebrospinal fluid circulation in early cases. Those with increased intracranial pressure should take antihypertensive measures. 18.2 Surgical treatment
The indications for surgical treatment are limited to cases of spinal arachnoiditis with localized adhesions and cyst formation. In cases of diffuse adhesions, the blood vessels and pia mater supplying the spinal cord and nerve roots are entangled. Together, attempts to separate these adhesions will cause further damage to the spinal cord and blood vessels. Severe adhesions are formed in the late stage of the disease, and the nerve parenchyma is degenerated, which is also a problem that is difficult to solve with surgery. Even if surgical separation is reluctantly performed, there is a possibility of re-adhesion. However, when there is cyst formation or it cannot be ruled out that there is a space-occupying tumor in the spinal canal, laminectomy and exploration should be performed. If there are signs of acute infection or a significant increase in cerebrospinal cells, surgery is not appropriate.
During the operation, it is necessary to observe whether the pulsation of the dura mater is normal and whether it is thickened. When incising the dura mater, try to keep the arachnoid intact, observe the color, transparency and adhesion, and separate it according to the specific situation. , do not force separation to avoid aggravating the injury. ① Separate localized cord-like adhesions; ② Correct the distortion of the spinal cord caused by adhesions; ③ Relieve the compression of the cyst, remove the cyst fluid, and remove as much of the cyst wall as possible without increasing spinal cord damage; ④ Exploring whether there are any abnormalities in the spinal canal Primary lesions such as tumors; ⑤ During the operation, a fine urinary catheter can be used to gently explore and flush up and down. Do not directly forcibly separate the adherent spinal cord, nerves and blood vessels to avoid increasing the damage to the spinal cord and nerves. Comprehensive treatment and enhanced care should be used after the operation. , prevent the occurrence of complications, and actively promote the recovery of neurological function. For cases with long arachnoid adhesions, surgery must be done with caution. Even if the adhesions are separated at the time, the adhesions may continue after surgery, so it is difficult to achieve good results. 19 Prognosis
For those who have no obvious obstruction in the subarachnoid space and whose limbs are only paralyzed, the prognosis is generally good, and most can recover to varying degrees with drug and other treatments. 20 Prevention of spinal arachnoiditis
Timely treatment and prevention of various primary diseases; prevention of infection of adjacent tissues of the spinal cord involving the spinal arachnoid; strict implementation of routine diagnosis and treatment operations to prevent neurosurgery and diagnosis and treatment operations. of hospital-acquired infections. 21 Related drugs
Prednisone, dexamethasone, hyaluronidase, dibazole, scopolamine, penicillin, streptomycin, hydrocortisone, cortisone, methenamine, Glucose, potassium iodide, niacin 22 related examinations
Cerebrospinal fluid pressure, nicotinic acid Spinal arachnoiditis-related drugs Iotrilan injection
After myelography, the cell count in the cerebrospinal fluid increased slightly , there are no reported cases of arachnoiditis. The most common reactions are headache, nausea and vomiting, but... Iotriran Injection
After myelography, the cell count of the cerebrospinal fluid increased slightly, and there are no reports of cases of arachnoiditis. The most common reactions are headache, nausea and vomiting, but... Iotriran Injection
After myelography, the cell count of the cerebrospinal fluid increased slightly, and there are no reports of cases of arachnoiditis.
The most common reactions are headache, nausea and vomiting, but... More spinal arachnoiditis related drugs
Human body surface area calculator BMI index calculation and evaluation Female safety period calculator Due date calculator Pregnancy weight Growth normal value drug safety classification during pregnancy (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes dietary recommendations Clinical biochemistry Common units conversion Basal metabolic rate calculation Sodium supplementation calculator Iron supplementation calculator Prescription Common Latin abbreviations Quick check pharmacokinetics Quick Check of Common Symbols Effective Plasma Osmolality Calculator Ethanol Intake Calculator